Pain Lies

The other week a new patient came into the clinic with chronic knee pain. He had been to several specialists over the past year who had diagnosed him with a tear to the meniscal cartilage of the knee. One orthopedic surgeon had advised this patient to have his knee surgically “scoped” — physical therapy was at this point a last-ditch, conservative effort to avoid surgery.

The patient’s pain was specifically in his left knee. He could point to the general area where it hurt, although I had a hard time localizing a focal point of pain when I pressed into the knee joint line with my fingers. Moving the knee into full flexion (bending) and extension (straightening) will very often provoke pain in a torn or otherwise inflamed meniscus. This patient had no increase in pain with these motions. Something was not adding up.

Another observation that struck me as odd: This patient complained of knee pain particularly when he sat for more than an hour. Why would his pain be present when he wasn’t placing much stress on his knee?

As it turned out, his pain was not actually due to any problem in his knee. This man had a nerve root in his lower back that was being pressed upon by a bulging disc. The stressed nerve root was sending pain down into his knee.

This patient effectively demonstrates the adage that I believe more and more every year that I practice:
Pain lies.

The “referred pain” phenomenon is more common than you think. Not only can pain come from the nerves of the spine, but also from the gall bladder, kidneys, and other organs.

The take-home message here is that if you have stubborn pain in a certain area of your body and your doctor is having difficulty diagnosing it, there is a good chance that your pain is not coming from the obvious location. Ask your doctor to check your spine and organs in order to get a larger picture of what may be the root cause of your pain.

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ABOUT THE AUTHOR

Daniel Baumstark, CHT

Daniel is a licensed physical therapist and the owner of PhysioDC (physiodc.com ), a sportsmedicine clinic in downtown Washington DC. He graduated in 1998 with clinical honors from the Washington University...read more

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